Multimodal ophthalmic imaging of staphylococcus aureus bacteremia associated with chorioretinitis, endocarditis, and multifocal brain abscesses

Purpose: Staphylococcus aureus bacteriemia (SAB) as critical condition for the life and occasionally involves the eyes. The aim of this report is to describe the ocular involvement with multimodal imaging. Observations: A patient admitted for evaluation of acute onset of confusion, disorientation, and generalized malaise and found to have methicillin-resistant staphylococcus aureus (MRSA)-associated endocarditis and multifocal brain abscesses was evaluated by the ophthalmology service. The patient's visual acuity was 20/20 OU without relative afferent pupillary defect and normal intraocular pressures. Bedside anterior segment examination was normal. Posterior segment examination revealed intraretinal hemorrhages and Roth spots in the posterior pole of the right eye, and two deep well-defined focal white chorioretinal infiltrates and a hemorrhagic pigment epithelium detachment in the temporal quadrant of the left eye. Multimodal imaging was utilized to document these findings and ensure adequate antibiotic therapy. Conclusion: SAB has the potential for poor visual outcomes as well as significant morbidity and mortality. Multimodal imaging of SAB-related chorioretinitis allows for accurate diagnosis as well as assessment of response to antimicrobial therapy

Refractile superficial retinal crystals and chronic retinal detachment: Case report

BACKGROUND: Few previous reports have described the presence of retinal refractile opacities at the macular area in patients presenting with longstanding peripheral retinal detachment. The exact nature of these opacities is unknown. CASE PRESENTATION: Two patients were referred with an abnormal appearance of refractile opacities in the macular area noted during routine examination. Both were found to have longstanding peripheral retinal detachments. Subretinal fluid analysis of one patient revealed the presence of multiple birefringent crystals. We hypothesise that these crystals are the origin of the refractile macular opacities noted. CONCLUSION: This report describes the rare presentation of asymptomatic peripheral retinal detachment by the detection of refractile macular opacities on routine examination. It highlights the importance of meticulous peripheral retinal examination in these cases. The article also describes the findings of the subretinal fluid analysis and discusses the possible hypothesis behind their appearance

Combined reduced fluence photodynamic therapy and intravitreal ranibizumab for polypoidal choroidal vasculopathy

Purpose: We performed a prospective noncomparative study to report the results of reduced fluence photodynamic therapy (PDT) combined with intravitreal ranibizumab in patients with polypoidal choroidal vasculopathy with active exudation and hemorrhage. Methods: Seventeen polypoidal choroidal vasculopathy eyes were treated, and followup for all patients was 12 months. Photodynamic therapy was administered with reduced fluence (exposure time of 70’’) and followed (48 hours later) by intravitreal ranibizumab (0.5 mg in 50 mL). Intravitreal ranibizumab, with or without reduced fluence PDT, was repeated as indicated by clinical and angiographic findings. Results: During the follow-up, the mean best-corrected visual acuity significantly improved from 0.45 ± 0.29 logarithm of the minimum angle of resolution at baseline to 0.29 ± 0.28 logarithm of the minimum angle of resolution at 12 months. The mean total macular volume (documented by optical coherence tomography retinal map examination) decreased from 7.5 ± 1.18 mm3 to 6.7 ± 0.8 mm3. In 95% of the cases, best-corrected visual acuity remained stable or improved. Conclusion: Reduced fluence PDT limits laser exposure, minimizing the risks of PDTinduced adverse effects. Intravitreal injections of ranibizumab 0.5 mg reduced bleeding and leakage in polypoidal choroidal vasculopathy eyes and interfere with rebound upregulation of vascular endothelial growth factor because of PDT-induced choroidal hypoperfusion. Combined treatment may improve treatment outcomes in polypoidal choroidal vasculopathy while minimizing ocular and systemic complications of treatment

Combination therapy with dexamethasone intravitreal implant and macular grid laser in patients with branch retinal vein occlusion.

PURPOSE: To test a combination of dexamethasone intravitreal implant with macular grid laser formacular edema in patients with branch retinal vein occlusion (BRVO). DESIGN: Prospective interventional, randomized, multicenter study. METHODS: Patients with macular edema secondary to BRVO underwent an Ozurdex intravitreal implant at baseline. After 1 month, patients were randomly assigned to 2 study groups. Patients in Group 1 were followed up monthly and retreated with Ozurdex implant whenever there was a recurrence of macular edema or a decrease in best-corrected visual acuity (BCVA). In Group 2 patients macular grid laser was performed between weeks 6 and 8. After that, patients were followed up and retreated as for Group 1. RESULTS: In Group 1 at 4 months, mean BCVA was 0.49 ± 0.35 logMAR and central retinal thickness (CRT) was 391±172mm; both improved significantly at 6months, to 0.32 ± 0.29 logMAR and 322 ± 160mm, respectively. In Group 2, CRT was reduced significantly to 291 ± 76 mmat 4months, andBCVAimproved to0.25±0.20logMAR.At the final visit, BCVA was 0.18 ± 0.14 logMAR and mean CRT was 271 ± 44 mm. The number of Ozurdex implants at 4 months was 12 of 25 (48%) in Group 1 patients vs 3 of 25 (12%) inGroup 2 patients (P[.012). At 6months 3 of 25 patients (12%) in Group 1 vs 0 of 25 (0%) in Group 2 (P [ .23) were retreated. CONCLUSIONS: The combination of Ozurdex implant and macular grid laser is synergistic in increasing BCVA and lengthening the time between injections

Choroidal Vascular Changes in Multiple Evanescent White Dot Syndrome

Purpose: To evaluate choroidal structural changes in patients with multiple evanescent white dot syndrome (MEWDS) during the acute and recovery stages. Methods: Enhanced-depth imaging optical coherence tomography (EDI-OCT) scans of 16 patients with unilateral MEWDS were acquired during the acute and recovery stages in both eyes. Images were binarized with the ImageJ software to measure subfoveal choroidal thickness (CT), total choroid area, luminal area and choroidal vascularity index (CVI). Results: In the acute stage, subfoveal CT, total choroidal area and CVI were significantly higher in eyes with MEWDS compared to fellow eyes (371.2 ± 101.8 vs 317.1 ± 90.3 µm, p = .001; 2.826 ± 0.686 vs 2.524 ± 0.674 mm2, p = .014; 69.49 ± 3.51 vs 68.27 ± 3.41%, p = .044, respectively). In the recovery stage, subfoveal CT, total choroidal area and CVI in eyes with MEWDS significantly decreased to respectively 333.4 ± 90.5 µm, p = .007, 2.592 ± 0.570 p = .002, and 67.31 ± 2.74%, p = .014. Conclusions: Choroidal thickness and vascularity are significantly increased during the acute stage of MEWDS

Dual Antagonism of PDGF and VEGF in Neovascular Age-Related Macular Degeneration: A Phase IIb, Multicenter, Randomized Controlled Trial

Purpose: To assess the safety and efficacy of E10030 (Fovista; Ophthotech, New York, NY), a plateletderived growth factor (PDGF) antagonist, administered in combination with the antievascular endothelial growth factor (VEGF) agent ranibizumab (Lucentis; Roche, Basel, Switzerland) compared with ranibizumab monotherapy in patients with neovascular age-related macular degeneration (nAMD).Design: Phase IIb global, multicenter, randomized, prospective, double-masked, controlled superiority trial.Participants: Four hundred forty-nine patients with treatment-naive nAMD.Methods: Participants were randomized in a 1: 1: 1 ratio to 1 of the following 3 intravitreal treatment groups: E10030 0.3 mg in combination with ranibizumab 0.5 mg, E10030 1.5 mg in combination with ranibizumab 0.5 mg, and sham in combination with ranibizumab 0.5 mg (anti-VEGF monotherapy). Drugs were administered monthly in each of the groups for a total duration of 24 weeks.Main Outcome Measures: The prespecified primary end point was the mean change in visual acuity (VA; Early Treatment Diabetic Retinopathy [ETDRS] letters) from baseline to 24 weeks.Results: No significant safety issues were observed in any treatment group. The E10030 (1.5 mg) combination therapy regimen met the prespecified primary end point of superiority in mean VA gain compared with anti-VEGF monotherapy (10.6 compared with 6.5 ETDRS letters at week 24; P = 0.019). A dose-response relationship was evident at each measured time point commencing at 4 weeks. Visual acuity outcomes favored the E10030 1.5 mg combination therapy group regardless of baseline VA, lesion size, or central subfield thickness on optical coherence tomography. All clinically relevant treatment end points of visual benefit (>= 15 ETDRS letter gain, final VA >= 20/40 or >= 20/25) and visual loss (>= 1 ETDRS line loss, >= 2 ETDRS line loss, final VA >= 20/125 or >= 20/200) favored the E10030 1.5 mg combination group.Conclusions: In this phase IIb clinical trial, a 62% relative benefit from baseline was noted in the E10030 1.5 mg combination therapy group compared with the anti-VEGF monotherapy group. A favorable safety and efficacy profile of E10030 combination therapy for nAMD was evident across multiple clinically relevant end points. This highly powered study provides strong rationale for a confirmatory phase III clinical trial. Ophthalmology 2017; 124: 224-234 (C) 2016 by the American Academy of Ophthalmolog